Bioethics in Practice—A Quarterly Column About Medical Ethics: Do You Remember the Hippocratic Oath?

To the uninitiated the following may sound trite, but the foundation for bioethics as it relates to physicians not only dates back to Hippocrates but also maintains its relevance through variations of the Hippocratic Oath. As I reflect back to my medical school graduation in St. Louis in the 1970s, I remember the act of reciting the oath but not the oath itself. As an associate dean of the Wayne State University School of Medicine, I recall participating in the administration of the oath to our new graduates, but, alas, I remember it as just another step in the graduation ceremony before I could rid myself of my cap and gown.

I may sound cynical, but I believe I am not an exception in the medical field. I can see in the faces of our young medical students and residents the eagerness to gain knowledge, to learn new procedures, and to become involved with patients. Their road through premed and medical school has been long; they want to get on with it. The medical school curriculum, the assessment of students' knowledge, accrediting bodies, licensing boards, and board certification all deal primarily or mostly with what I call technical content. Does this adequately prepare future doctors to legitimately take the Hippocratic Oath and adhere to it?

I specifically call to your attention the following key phrases from the oath:

• “… gladly share such knowledge as is mine with those who are to follow …”

• “… warmth, sympathy, and understanding may outweigh the surgeon's knife. …”

• “… must I tread with care in matters of life and death…If it is given to me to save a life, all thanks…may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty …”

• “… I do not treat a fever chart, a cancerous growth, but a sick human being. …”

• “… I remain a member of society with special obligations to all my fellow human beings. …”

In our profession, we not only heal, but we also educate. We educate future physicians, other healthcare providers, our patients, our community, our colleagues, and yes, ourselves, all because of the oath we have taken. We are treating a person: someone's father, mother, sister, daughter, son, spouse. We are not treating diabetes, heart failure, or kidney stones.

We have all gone into medicine because we want to help people. We probably are at least above average in prosocial traits. However, a certain inurnment to pain and suffering unfortunately develops during medical education and tends to move us away from altruistic traits. Physicians have moved away from a historically strong social contract with our community to a commercial contract.

Although our oath alone should keep us centered, it generally has not. Fortunately, medical education is a never-ending continuum: undergraduate to graduate to continuing medical education. We have ample opportunity to instill and refresh the spiritual and humanistic components of our profession. I have been energized in particular by 2 opportunities: the inception of the Ochsner Clinical School as part of The University of Queensland School of Medicine and my involvement with the Accreditation Council for Graduate Medical Education (ACGME) Board.

These venues give me a renewed opportunity to influence the ethical standards of caring for people. I remind our medical students that they are now in the professional aspect of their education. They no longer are cramming for examinations as they did in college but are simultaneously learning a science and a healing art. The ACGME has given us the ability to use patient safety and quality outcomes in our process of accrediting our graduate medical education training programs through the Next Accreditation System.

Most important, I now pay attention when I read or hear the Hippocratic Oath.